14 January 2004
For the past 10 years, South Africa’s innovative “miracle” train, Phelophepa, has brought primary health care to rural areas where, according to government statistics, there is one doctor for every 4 000 to 5 000 patients.
Phelophepa – a seSotho word for good, clean health – came into being in January 1994 when parastatal Transnet’s corporate social investment department and the optometry unit of the Rand Afrikaans University joined up to provide rural South Africans with primary eye care.
The train initially had only three carriages and was solely financed by Transnet. Now Phelophepa has 16 carriages, and a host of companies have joined in the programme as sponsors.
It is the first and only primary health care train in the world, and one of the most ambitious corporate projects ever undertaken in South Africa.
Phelophepa travels around the country for 36 weeks of the year, stopping at least five times at each of 36 stations in the Free State, Western Cape, KwaZulu-Natal and Mpumalanga.
About 40 000 patients receive treatment at the train’s various clinics each year, and more than one million people have been reached to date.
This year, Phelophepa will visit the Eastern Cape, Northern Cape, Limpopo and North West provinces. Gauteng, which is deemed urban, is excluded from the train’s itinerary.
Lynne Coetzee, Transnet’s portfolio manager for health, suggested the idea of expanding the train’s facilities to turn it into an holistic travelling health care service that will reach thousands of rural communities.
Student volunteers work alongside 15 full-time staff to provide basic health services – including general, dental and eyecare – in the rural areas. Public awareness about health issues, including HIV/Aids, is also promoted.
The train has a unique power car which generates enough electricity to supply a small town for two weeks.
Under normal operating conditions the drive wheels of the passenger coaches generate enough electricity for lights and hot water. But as the Phelophepa provides its services while stationary, another power source had to be found, and a dedicated power generator was essential.
Old coaches were refurbished to accommodate an Edu-Clinic, which is equipped to teach groups of 25 local volunteers about basic health issues, with a medicine clinic which houses a pharmacy, the Roche health clinic with five examination clinics and an office, the Colgate dental clinic with five dental chairs, a psychology clinic with two consultation rooms, and two coaches that serve as an eye clinic.
The train also has a dining car for 40 people and a kitchen where nearly 200 meals are prepared each day. Four carriages contain sleeping compartments and a laundry with five washing machines, tumble driers and ironing boards for use by the 56 people on board.
The Transnet Foundation has announced that it will provide 48 percent of the train’s funding for the 2004 financial year. It said the train’s monthly expenditure – despite escalating costs – is estimated at R1.5-million, which translates to about R60 to R70 per patient. The remaining 52 percent will be covered by corporate sponsors.
Roche, a research-oriented healthcare group which has partnered Transnet in the project since 1994, also announced a substantial financial injection for the train. Roche has paid the costs of the health clinic as well as the vehicle used by staff to visit surrounding villages and schools.
The company said its additional sponsorship will be used to expand services on the train. These will include adding new clinics for diabetes care and oncology. The school health services project will also be extended, while additional funds will be spent to maintain the train and the communications infrastructure.
The inclusion of diabetes and oncology care will cover urgent needs. According to Pat Senne, head of corporate affairs and communication for Roche SA, Type II diabetes is becoming increasingly significant in rural South Africa – yet it is a problem that can be prevented.
“Diet and obesity can predispose people to Type II diabetes, so we hope to add value to Phelophepa by educating patients on how to eat properly and recognise symptoms of the disease,” Senne told The Star newspaper.
In addition, the health clinic will screen patients for cancer, a disease which affects a frightening number of people with lumps on the body but who are unaware that something could be wrong. Although cancer cannot be treated on the train, if it is detected patients will be directed to the nearest hospital.
Roche has has also undertaken to fund the school health screening and education service and the dispensary.
Jorg-Michael Rupp, Roche SA’s chief executive officer, told The Star: “Phelophepa is one of Roche’s flagship global projects and it is a rewarding example of how we support socially responsible and sustainable projects.
“The train is impressive not only as it is an effective service to the poorest of the rural poor, but because of its ability to uplift the whole community.”